Surgery: Phacoemulsification

This video demonstrates a regular phacoemulsification surgery in a patient with a sporadic cataract. All the regular steps were performed and the nucleus was removed using a modified stop and chop technique. An IOl was implanted in the capsular bag and the ports were hydrated.

Transcript

Dr. Stephen Lane: And there’s really nothing special, you can see it’s a combination of a nuclear sporadic cataract and you can see the posterior subcapsular component of this.

Next I will put in some viscoat and again fill it about two thirds of the full with viscoat and then a one third full with provisc.

And what that does is, the provisc forces the viscoat up against the endothelium and at the same time lays a surface down on the capsule. Now I’d like to make a little groove rather than going straight in, many people like to just go straight in with the keratome. I feel like it gives me something to aim at. It’s about just a third of the thickness and now I will bend the needle for my capsularhexis.

The nice thing about doing capsularhexis with a needle is if you need to you could actually do this through a paracentesis, although it’s nice to have the extra room through the main primary incision. And we’re just going to make a few punctures and then pull. Then you get the capsule to fold over.

So that you work from the underside as you can see here. And this allows you then to guide this along and create a capsularhexis, that’s very much round and central. I like to use the pupil as a template so that I try and stay in the same distance away from the pupil all the way around for 360 degrees, that assures that we have a round and central capsularhexis. So you can see it’s roughly the same distance all the way around and that size is about five millimeters. And then I’d like to just pull the remnant out.

Now, next we’ll do a hydrodissection. So you should see a nice fluid wave. So you can see a very nice fluid wave and then I like to push down right in the middle.

So I like to go in on continuous irrigation, that way you don’t have to worry about coming off the foot pedal and shallowing the chamber. And you sculpt and you only turn on the phaco, you only go to foot position three, you can see the first thing I did is, I made it wide enough and then I always check my parameters to make sure there are what I want them to be.

So we’re in sculped mode and you can see that I’ve got a vacuum that’s linear up to 90. My flow rate is 24 set and the oscillatory motion is at 100 percent but only when I go all the way to the bottom of foot position 3.

And I don’t ever do that very often unless it’s a very hard lens.

And now you can see that I’m probably about three and a half phaco tips depth and I’m just on irrigation only now, there’s no aspiration. I’ll put my second instrument in through the side port and I’ve got to get to the bottom, go to the base and then it breaks very easily.

So I’ve got a crack all the way through. I’m going to create now just a little pie shape. Because we’ll do this mostly as a chop, this is sort of a modification of the Stop and Chop.

And I know exactly how deep to go because I know how deep I made my original trof. You go to the base, and you pull apart and you crack. And now I’ve got this little quadrant right over here. And if I want I can go right in behind it, and kind of force it and pull it into the front of the eye.

And now I’m going to switch parameters. And so now my vacuum is higher. And so we’ll just go ahead and remove that little segment, you can see it so loose the other ones want to come and I’m just going to put that back.

I’m going to leave the phaco tip right where it is but this piece, that quadrant is up on top so I’m just going to sweep it down.

Now I’m going to go ahead and just impale this piece. Next you can see it continues to want to sort of get up above and not even moving my phaco tip.

Now once again keep to the side and go to continuous irrigation. Sometimes it’ll just go all by itself which I think it’s going to here. Usually by the time you call for your second instrument to mash it in, it’s already gone.